Moving on Program from Supportive Housing (MOSH): Practice & Program Strategies Arlington

8/12/2020

Moving On Program from Supportive Housing (MOSH): Practice & Program Strategies Arlington

Substantial sections of this powerpoint were adapted from Tiderington, E et al, “Moving on from Supportive Housing”, Rutgers University, 2018.

Andrea White Email: [email protected]

Agenda . Introductions . What is Moving On? . Why Implement Move On Strategies? . Program Strategies . Core Program Features . Stages of Moving On . Creating a Culture of Moving On . Practice Interventions . Identifying Candidates and Assessments . Pre-MOSH Planning . Finding Housing . Post-MOSH Planning . Closing

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Zoom, zoom zoomerating ◦ We will mute all of you at the beginning of the presentation. ◦ We will pause periodically through the presentation for polls, questions and discussions. ◦ If questions come up during the presentation, please write them in the chat box. ◦ The slides and resource materials will emailed out after the session by The Planning Council.

Thoughts on Problem Solving Skills Last Week: Stabilizing in PSH Tenancy Skills and Resources Developing a Network of Care Housing Stabilization Pro-Active Housing Planning Session Crisis Planning • Thoughts Mentoring for Services Going Forward • Reflections

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Introductions Poll .Why are you here today? . I have tenants ready to move on . I have no tenants ready to move on . I want to start a moving on program at my housing authority . I want to start a moving on program at my agency . I am curious about the program model . Our system has no vacancies in PSH (permanent supportive housing) and we need to get some flow to house high need people . My boss told me to come . None of the above – please type in chat box

What is Moving On? ◦ Help tenants who no longer require on-site services to transition from supportive housing to private apartments with, or without, rental support and less intensive community-based services.

◦ Allows providers to then fill now-empty units with people who are most in need of supportive housing. (CSH, 2016)

◦ Has become a HUD focus – question in 2019 Continuum of Care NOFA Competition

◦ Earliest efforts starting almost 20 years ago

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What is Moving On - 2?

.Spirit of Moving On .Recovery-oriented .Promotes self-determination .An individualized process .Voluntary .Self-directed by the consumer .A process that starts at move in

Moving On – Paying for Housing ◦ Many people need a long-term/permanent subsidy ◦ Set asides of Section 8/Housing Choice vouchers ◦ Units in affordable properties ◦ Employment ◦ Back pay from mainstream benefits ◦ Family reunification ◦ Major life changes- marriage, new relationship, children, etc. ◦ VA Home Loans

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Financial support for moving expenses like: ◦ Security deposits Moving On – ◦ First and last month’s rent Services and ◦ Purchasing household items: furniture, dishes, appliances Financial Case management support for: ◦ Identifying, securing and setting up the new home and Assistance acclimating to the neighborhood ◦ Increasing income ◦ Help with developing positive relationships with landlords ◦ Providing education on financial management and tenancy rights/responsibilities ◦ Crisis planning, negotiation, problem-solving, refusal and conflict resolution skills ◦ Bridging resources ◦ Establishing new goals, routines and connections to formal and informal supports ◦ Building confidence in succeeding

Pause for questions and comments.

How many of you are doing moving on already? If so, what has been most important in your direct practice with participants?

Please indicate in the chatbox or raise your hand if you would like to comment.

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Features of a Successful Moving On Program

◦ Moving on is introduced at the beginning of tenancy in supportive housing and discussed regularly during service plan reviews ◦ Focus on consumers who will be successful ◦ Requires all hands-on deck! ◦ Strong communication ◦ Training in Evidence Based Practices ◦ Critical Time Intervention ◦ Motivational Strategies using Motivational Interviewing Tools ◦ Culture of Moving On ◦ Peer Support

Stages of MOSH Adapted from Stages of Change - Prochaska, J.O. & DiClemente, C.C. (1983). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 20, 161-173.

Maintenance

I know how to do this!

Action

I’m out of here! Preparation

What do I have to do Contemplation to get out of this place? Pre-Contemplation Maybe I would like to get my own place Why Move On? one of these days. I just got here! Stages of Moving On from Supportive Housing

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Stages of MOSH: Pre-Contemplation

Pre-contemplation : A person has not yet identified an issue as a problem and is not currently considering change. Staff Roles: ◦ Introducing consumers to the idea of MOSH ◦ Educating consumers about MOSH options ◦ MOSH success stories ◦ Using open ended questions to help consumers think about future goals

Stages of MOSH: Contemplation

Contemplation : A person begins to identify an issue as a problem and is thinking about but ambivalent about change.

Staff Role ◦ Exploring ambivalence ◦ Have conversations about what is expected to move out and be realistic - budgeting, finances, etc. Bringing these things to life really motivates people to think if they are ready and make their own decision (CSH, 2016) ◦ Use “Decisional Balance Sheet” to explore the Pros and Cons of staying and of moving on

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Decisional Balancing

Benefits Costs

Staying in Supportive Housing Moving On from Supportive Housing Elicits statements of Why consumers want to Move On

Challenges and Benefits of Moving On

CHALLENGES BENEFITS ◦ Loss of connections with the ◦ Freedom from service providers community ◦ Increased independence ◦ Increased responsibility ◦ Safer, more peaceful environment ◦ Managing mental and physical health conditions ◦ Reunite with family/friends ◦ Housing/neighborhood quality can ◦ Better access to work/services etc. decrease ◦ More social/community integration ◦ Moving On is expensive CSH, 2016 Tiderington, Livingstone, & Herman, 2017

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Importance and Confidence Ruler

Importance Ruler: ◦ “On a scale of 1 to 10, how important is it for you to Move On from PSH” ◦ “Why are you a ____ and not ___?” ◦ Your number should be 2-3 digits lower than the consumer's Confidence Ruler: ◦ “On a scale of 1 to 10, how confident are you that you can Move On from PSH”? ◦ “Why are you a____ and not ___”? ◦ Your number should be 2-3 digits lower than the consumer's ◦ “What would it take for you to be a _____” ◦ Your number should be 2-3 digits higher than the consumer’s

Stages of MOSH: Preparation

Preparation : A person is planning to make a change. They seek out information and support, they are “testing the waters.” ◦ Be trauma-informed and educate your consumers on what to expect during the MOSH process ◦ Planning support for the process ◦ Consumers in this stage usually have the capacity to save money and are tenants in good standing, up-to- date on their rent, etc.

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Stages of MOSH: Action Action : A person actively begins making changes in his or her life. They are practicing new behavior(s). ◦ Making a Pre-MOSH Service Plan ◦ Securing Income and Benefits ◦ Budgeting/Financial Planning ◦ Enhancing Tenancy Skills ◦ Resolving Tenancy Barriers ◦ Executing the Housing Search Process ◦ Creating a Post-MOSH plan to be executed after moving on in maintenance phase ◦ Connecting to External Support Services and Resources ◦ Eviction Prevention ◦ Crisis Planning ◦ Income Growth

Stages of MOSH: Maintenance

Maintenance/Relapse: A person sustains behavior change OR a person resumes old behaviors. Relapse is considered a part of the change process. Staff Roles ◦ Check-ins and aftercare: formalize this process ◦ Updating the Post-MOSH Plan ◦ Relapse prevention plan, as it relates to housing ◦ Eviction prevention planning

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Polls ◦ Do you have tenants in your program who could successfully move on? ◦ Do you have participants in your program who are already in the Preparation or Action stage? ◦ Please use chat box to elaborate or indicate if you would like to comment.

Creating a Culture of Moving On

Strategies ◦ Integrate Moving On into service plan discussions ◦ Publicize and celebrate moving on opportunities ◦ Moving On group for peer support ◦ Bring back alumni to meet with potential movers ◦ Peer-run alumni activities (e.g., celebrating holidays, etc.) ◦ Integrating MOSH into your supervision People are resistant to change. Moving On usually requires a significant organizational culture shift, and it starts with people who have already done Moving On. ◦ Must do cost/benefit analysis

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◦ Losing your favorite consumers Challenges for ◦ Fearing they won’t succeed without you Providers ◦ Lack of community resources for support post move on ◦ Lack of affordable housing ◦ Housing Authority not engaged ◦ Additional workload – getting new higher need tenants and following people who have moved on ◦ Lack of funding ◦ Organizational culture/mission conflict

Benefits for the ◦Provides “churn” so others can access Provider and supportive housing units ◦Landlords/PHA serve homeless system System and tenants who have successful track record as a tenant/following a lease ◦Helps people achieve a “life after case management” ◦Staff feel a sense of success in their work ◦Follows the aim of the recovery model to encourage people to move forward ◦Can serve higher-need more vulnerable people in vacated supportive housing units

◦ 24 24

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Pause for discussion

*How does this align with your agency’s mission? *How will you “sell” this in your agency? * What reservations do you have about Moving On? * What reservations do you think your leadership will have? Your staff? *What else do you need from your supervisor, your agency, or the CoC to be able to make Moving On part of your work? Please indicate in the chatbox or raise your hand if you would like to comment.

Identifying Candidates for MOSH

Not all people are candidates, but more are than you may think ◦ People with the desire and motivation to move on ◦ Individuals with good financial management skills ◦ Individuals with stable incomes, preferably employment but can be SSI/SSDI if rent subsidies/affordable units are available or person is willing to have roommates/live with others Individuals who have demonstrated the ability to maintain housing ◦ Individuals who have been able to follow their leases, manage their units and meet their responsibilities for a sustained period of time Individuals no longer in need of on-site services Individuals with portable vouchers Family reunification cases

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Assessing for Moving On ◦ Housing Plan and Goals ◦ Household Composition ◦ Income Sources and Amounts ◦ Debts ◦ Tenancy History and Lease Compliance ◦ References

I have a consistent source of income I have at least one month’s worth of rent saved in a bank account Self- I have the benefits in place that I need I am employed OR receive disability, if unable to work Assessment I have good credit I pay my rent on time I pay my utility bill payments on time * Yes or No The police have never been called to my apartment and I consider myself a good neighbor I understand the terms of my current lease in supportive housing I have a primary care doctor and go to annual check ups *Steps I need I am able to manage my doctor appointments without the help my case manager to take to If I was having trouble with my mood I would know where to get help work on this I am able to manage my medications without the help of my case manager I have connections in the community outside of my case manager that I can go to for help. (e.g. family, friends, AA, Sponsor, church, etc.) I have no legal issues that would impact my ability to move out I know how to navigate public transportation or have a car of my own I am able to live independently and keep my apartment clean I have food at all times in my apartment

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Creating a Pre-MOSH Plan

Informed by the MOSH Self Assessment Should focus on the areas identified by the consumer Can be used to supplement the service plans already in place at your organization Once the MOSH Self Assessment is completed, review the answers with the consumer and turn the areas of concern into SMART goals with specific methods to achieve these goals. ◦ SMART ( Specific, Measurable, Attainable, Realistic, Timely) Possible Goal Areas: ◦ Financial Capability ◦ Enhancing Tenancy Skills ◦ Resolving Tenancy Barriers ◦ Finding Housing

Pre-MOSH: Resolving Tenancy Barriers

Tenant screening is focused on the issues that are most important to landlords:

(Department of Veterans Affairs), 2017

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Pre-MOSH: Resolving Tenancy Barriers - 2

◦ Building/Repairing Credit ◦ Expunging Criminal Records ◦ Locating Eviction Records ◦ Positive Landlord/Property Manager Reference ◦ Preparing for Housing Interviews and Talking about Problematic Background issues ◦ Problem Solving Skills

Pre-MOSH: Resolving Tenancy Barriers - 3 Housing Retention Barriers are habits, or a lack of information or skills that are barriers to paying the rent, caring for the unit, interacting with the landlord or other tenants, and following the lease and the laws. Resolving Housing Retention Barriers often become a part of Pre-MOSH Plan. (Department of Veterans Affairs, 2017)

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Pre-MOSH: Enhancing Tenancy Skills

◦ Social Skills Training (SST) works with consumers on how they perceive social cues, problem solving and analyzing the situation, and then responding effectively. ◦ SST uses role-plays, practice, feedback and guidance to strengthen individuals’ interpersonal skills. ◦ SST helps consumers negotiate for their needs, manage neighbor, landlord and other relationships effectively, essential skills to live independently

Stan Debate ◦ Successfully maintained tenancy ◦ Member of agency Advocacy Committee ◦ Engaged in mental health treatment ◦ Brought me cheese ◦ Sweet as pie ◦ History of victimization ◦ Poll: Should Bert Move On?

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Pre-MOSH: Finding Housing Finding housing can be hard. Some techniques to identify new landlords, brokers, and management companies: ◦ Cold calls and word of mouth ◦ Keeping your eyes open ◦ Landlord networking meetings/landlord event ◦ Internet searches/brokers ◦ Network with other nonprofits and programs ◦ Teach your consumer how to do their own search ◦ Portable Section 8 vouchers ◦ www.gosection8.com Develop a Landlord Benefits Document

Staying in the Same Unit/Transitioning in Place ◦ You may be able to help consumers transition their scattered-site supportive housing unit into their own apartment. ◦ Help them to talk to the landlord. Can the lease be renewed under the consumer’s own name? Can they afford to pay market rent for the unit on their own? ◦ Can they apply a voucher/subsidy to this unit?

◦ Bonus: These landlords already know the tenant and may be more willing to rent to them. They are already familiar with the neighborhood and community so they’ll have existing supports in place. Eases the trnsition

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Pre-MOSH: Finding Housing

Know Basics of Renting and Any Subsidies ◦ Broker’s fee: usually between 1 month’s rent and 15% of annual rent ◦ Security deposit: usually between 1 and 2 months of rent ◦ Most of the time it is illegal for large landlords to discriminate based on source of income. This includes vouchers! You should always get information about the price of the apartment before introducing that the future tenant plans to pay with a voucher. Accompany people to view apartments, practice landlord interviewing skills, and attend lease-signing. Familiarize yourself with Virginia Housing Laws with resources from Virginia Legal Aid: ◦ https://www.valegalaid.org/issues/housing/landlord-and-tenant-issues A useful resource for training staff in basic housing rights is in Module 3 of SAMHSA’s PSH Training for Frontline Staff which can be found here: https://store.samhsa.gov/shin/content//SMA10-4510/SMA10-4510-03-TrainingFrontlineStaff-PSH.pdf ◦ - ADA, Fair Housing

Post-MOSH: Aftercare

Aftercare at Jericho Project, NY, NY ◦ Home visit during Month 1 ◦ Check-ins at Months 1, 2, and 3 ◦ Check-ins at Months 6, 9, and 12 Can use Critical Time Intervention (CTI) Model Focus on eviction prevention, lease compliance and support network Offer to help renew lease and if using a voucher, complete annual recertification and make sure landlord is aware Public Housing Authority (PHA) will be doing another inspection and assessment of rent reasonableness.

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Creating a Post-MOSH Plan

Connecting to Community Supports ◦ A ‘network of care’ is each person’s support system as they leave PSH. ◦ This will build on the resources and relationships developed in PSH. ◦ Helping people connect to resources (and resource gaps) is core to the EBP of CTI and essential for community stability. ◦ Look for both formal and informal supports ◦ Income, benefits, AND services ◦ Develop a person-focused resource list ◦ Review resources in current use ◦ Add resources developed through work with other tenants ◦ Identify needed connections

Post-MOSH: Planning for Termination and Stability

Start terminating Moving On support from the beginning. Make sure the consumer is aware of how often you will be checking in with them, and for how long. Let them know that even after Moving On support has ended, they can always reach back out if they have questions or concerns. Make sure they understand they cannot move back if there’s no “right of return.” As people are ready to move out we want to: ◦ Review work done together in PSH ◦ Ask each person to think evaluatively of their experience in PSH – ◦ what was helpful, what wasn’t, successes, challenges ◦ Hold meetings with the network of care to ◦ provide a handoff and plan for future support – “warm handoff” ◦ Develop longer term goals to give structure for moving forward ◦ Develop eviction prevention and crisis plans

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Themes for Participants

Building Skills

Pursuing Goals – Changing Structure & Expectations Purpose

Developing Assuming New New Roles Connections

Post-MOSH: Celebrating the Move!

◦ Moving On is a huge accomplishment for both the consumer and staff, and it’s important we celebrate it! ◦ Have events to celebrate the successes of consumers who’ve moved on. ◦ Stay connected with agency events and celebrations. ◦ Invite tenants to come back and talk to potential consumers interested in Moving On.

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Keys to Successful Implementation .Organizational buy-in and partnerships .Subsidies/subsidized units . Application/vetting process and coordination with CoC Coordinated Entry System .Culture of Moving On in the organization . Have ongoing discussions of Moving On with tenants (discuss at Service Plan Review) . Teach tenancy skills and address barriers to tenancy . Use Peers/Alumnae to build motivation and skills . Develop move-on plans and connect to community resources .Resources to provide aftercare (preferably for at least 6 months) (note on funding)

Final Discussion ◦ Polls ◦ Are you interested in implementing a Moving On program in your community/agency? ◦ Discussion Q’s – Please indicate in the chat box if you would like to comment ◦ What questions do you have about implementing moving on? ◦ What resources do you need to help people move on? ◦ What barriers do you anticipate? ◦ How will you promote this idea?

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References

Center for the Advancement of CTI at Silberman School of Social Work at Hunter College. www.criticaltime.org Corporation for Supportive Housing (2016): Moving On from Supportive Housing Evaluation Report. www.csh.org/wp-content/uploads/2016/07/CSH-LA-Moving-On-Final- Report_06.30.16_EW_AE.pdf Herman, D. & Conover, S. (2002). Critical Time Intervention Manual. https://www.criticaltime.org/wp-content/uploads/2014/05/CTI-Manual.pdf Homelessness Landscape Research. FSG Social Impact Advisors, 2010, Homelessness Landscape Research, https://hilton- production.s3.amazonaws.com/documents/12/attachments/Conrad_Hilton_Foundation_Homel essness_Landscape.pdf?1439580179 Kinnaman, J. (2009): VA Social Skills Training for Serious Mental Illness. https://www.mirecc.va.gov/visn5/training/sst/sst_ebp_coordinator_conf_2009.pdf Miller, W.R. and Rollnick S. (2012). Motivational Interviewing: Helping People Change. 3rd Edition. New York: Guilford Press.

References - 2

Prochaska, J.O. & DiClemente, C.C. (1983). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 20, 161-173. Substance Use and Mental Health Administration. (2010). Training Frontline Staff: Permanent Supportive Housing. https://store.samhsa.gov/shin/content//SMA10-4510/SMA10-4510-03- TrainingFrontlineStaff-PSH.pdf The Supportive Housing Network of New York (2006): A Snapshot of Supportive Housing in New York State. https://shnny.org/uploads/2006_Supportive_Housing_Population_Survey.pdf Tiderington, E., Livingstone, K. & Herman, D. (2017, January). Consumers' motivations for leaving permanent supportive housing through a Moving On Initiative. Oral presentation at the Society for Social Work and Research Annual Conference, New Orleans, LA. United States, Department of Housing and Urban Development, Landlord Engagement & Recruitment Desk Book.” Landlord Engagement & Recruitment Desk Book, Sept. 2015. www.hud.gov/sites/documents/LANDLORD-DESKBOOK.PDF

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Credits

The “Moving on from Supportive Housing (MOSH)” training was developed for a State of New Jersey Department of Community Affairs-funded study entitled “Developing and Assessing a Critical Time Intervention-Informed Case Management Skill-Building Curriculum to Support Resident Transitions from Supportive Housing.”

Principal Investigator: Emmy Tiderington Co-Principal Investigator: Allison Zippay

Collaborators: Adriana Rodriguez Kelly O’Sullivan Andrea White Suzanne Wagner Rachel Hood

Editor and Graphic Designer: Bebe Smith